Effects of group counseling with cognitive-behavioral approach on reducing psychological symptoms of Premenstrual syndrome (PMS)

[Premenstrual dysphoric disorder (PMDD): Drug and psychotherapeutique management, a literature review]

INTRODUCTION

Premenstrual Dysphoric Disorder (PMDD) was first recognised in July 2013 in the DSM-5 after a long journey to identify its existence. It was not until 1983 that the US National Institute of Mental Health determined research criteria for the study of PMS. In 1994, the term "premenstrual dysphoric disorder" (PMDD) replaced this term in the 4th edition of the Diagnostic System Manual (DSM). It was listed in the section "Mood Disorder Not Otherwise Specified" and remained under consideration until the DSM-5, in which it appeared in the depressive disorders section. The legitimisation of the psychiatric diagnosis as well as the determination of clear symptomatology criteria in 2013 opened up possibilities for management, development of clinical, pathophysiological, therapeutic and psychotherapeutic studies. This disabling disorder can affect personal, social, family and professional life. In 2019, the ICD-11 in turn introduced the diagnosis of premenstrual dysphoric disorder, which solidifies the recognition of the disorder.

OBJECTIVE

(I) to review the existing treatments, both medicinal and psychotherapeutic, and (II) to review their effectiveness. At the end of this work we will formulate recommendations for the management of these patients.

METHODOLOGY

A bibliographic search was carried out from 7 June 2021 to 7 July2021 on the databases (bases de données) Psychinfo APA, Scopus, PubMed, as well as the bases de données of the Cochrane organisation and the recommendation documents of the Haute Autorité de la santé. After an initial selection based on keywords, the full text of all articles were read to arrive at the final selection of 32 articles.

RESULTS

Antidepressants and Cognitive Behavioural Therapies (CBT) appear to be the most commonly recommended treatments for PMDD. Other research shows the effectiveness of oral contraceptives including drospirenone. Selective serotonin reuptake inhibitors (SSRIs) were identified as an effective treatment for PMDD. These data are consistent with the current etiological hypothesis of PMDD which has a negative impact of natural hormonal fluctuations on certain neurotransmitters. CBT showed positive results in reducing the functional impact of PMDD.

DISCUSSION

Selective serotonin reuptake inhibitor (SSRI) antidepressants were reported to be first-line treatments for PMDD (sertraline 50-150 mg/d, fluoxetine 10-20 mg/d, escitalopram 10-20 mg/d, paroxetine 12.5-25 mg/d). Drospirenone (EE 3 mg and EE 20 mg/d 24 days of hormonal pills, 4 days inactive) appears to have been a first or second line treatment depending on the articles. Current results clearly point to the effectiveness of CBT in helping to reduce: functional impairment, depressed mood, feelings of hopelessness, anxiety, mood swings, sensitivity, irritability, insomnia, conflict with others, impact of premenstrual symptoms on daily life, intensity of symptoms experienced, and symptom handicap. CBTs could also become a first-line treatment if there were to be more evidence of their effectiveness. In the future, it would seem useful to offer a psychotherapeutic treatment that can be reproduced and to multiply research with a high level of scientific comparability in order to clarify the place of CBT in the management of PMDD. Research on the etiopathology of the disorder and the optimal drug regimen is still ongoing. There is a need to develop appropriate psychotherapeutic techniques to support and accompany these patients.

CONCLUSION

In order to better evaluate treatments for PMDD, there is a need to homogenise studies on the subject at several levels: design, treatment doses, psychotherapeutic techniques, and evaluation measures. At present, some studies include both premenstrual syndrome (PMS) and PMDD patients. PMS and PMDD do not include the same symptoms, nor the same severity and potentially the same aetiology in the patients studied. In order to propose rigorous research that evaluates the effectiveness of treatments for PMDD and to properly support people with both these disorders, it seems essential to distinguish the two conditions. The role of the health practitioner is to be able to identify PMDD by differentiating it from other clinically related disorders. The patient must then be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications and her preferences. In 2021, the French National Authority for Health did not offer any guidelines or recommendations for the management of premenstrual dysphoric disorder. There is a need to develop research in France.

Effectiveness of Echium amoenum on premenstrual syndrome: a randomized, double-blind, controlled trial

Background

The present study aimed to evaluate the effect of Echium amoenum (EA) on the severity of premenstrual syndrome (PMS) in comparison with placebo.

Methods

The present study was a randomized double-blind controlled clinical trial. A checklist questionnaire was completed by 120, 18 to 35-year-old, college students. And then, 84 eligible women (20 to 35 years old) were enrolled in the trial; they were randomly assigned to two groups of intervention (EA) and control (placebo), with 42 participants in each group. Participants in the intervention group received 450 mg capsules of EA per day (three times a day) from the 21st day of their menstrual cycle until the 3rd day of their next cycle for two consecutive cycles. The severity of PMS was measured and ranked using the premenstrual symptoms screening tool (PSST). The generalized estimating equation was used to compare the total score of the severity of PMS between the two groups.

Results

Sixty-nine women with regular menstrual cycles suffering from PMS completed the study. The mean scores of the symptoms in the EA group were 35.3 and 16.1 (P ≤ 0.001) at baseline and after 2 months, respectively, while the mean scores of the symptoms in the placebo group were 31.0 and 28.3 (P = 0.09) at baseline and after 2 months, respectively. The evaluation of the first and the second follow-ups in the intervention group showed that, after being adjusted for age and body mass index (P ≤ 0.001), the mean scores of the premenstrual syndrome, using GEE analysis, have decreased to 6.2 and 11.6, respectively.

Conclusion

Based on the results, in comparison with the placebo group, EA was found to be more effective in improving the symptoms of PMS, and is highly recommended for treatment of this syndrome.

Trial registration

IRCT2015110822779N3; Registration date: 2015–11–27.

Short report: cognitive behavioral therapy - a primary mode for premenstrual syndrome management: systematic literature review

Most women in reproductive age experience at least one premenstrual syndrome (PMS) symptom every month over many years, and about 5% experience significant impairment, requiring professional intervention. Offering effective and sustainable treatment, is essential. While research acknowledges the effectiveness of nonpharmacological methods, cognitive behavioral therapy (CBT) and lifestyle modifications, as a treatment alternative, selective serotonin reuptake inhibitors or hormonal ovulation suppression continue to be recommended as a first-line treatment. We hypothesize that nonpharmacological methods will be sufficient for effective and sustainable PMS management. A systematic literature review was conducted for peer-reviewed original studies with the search terms: CBT, psychoeducation, PMS and premenstrual dysphoric disorder. All 32 identified studies found a significant reduction in PMS to complete remission with nonpharmacological interventions. No side effects were reported, and positive effect was sustained over time. Psychoeducational self-help packages, delivered with the affordance of modern technology, appeared to be enough for most women to manage successfully their PMS distress. Most severe PMS forms required one-to-one CBT. Nonpharmacological methods can be recommended as the primary mode for PMS management. More high-quality research is required, for developing personalized self-help packages, as well as the full use of modern technology for delivering the service.

The effects of psychoeducation based on the cognitive-behavioral approach on premenstrual syndrome symptoms: A randomized controlled trial

PURPOSE

The present study investigated the effects of psychoeducation based on a cognitive-behavioral approach on premenstrual syndrome (PMS) symptoms in young adult women.

DESIGN AND METHODS

The study was performed as a randomized controlled trial. The sample size was identified as 90 (45 intervention group/45 control group) students. The psychoeducation intervention consisted of five sessions performed over a 4-week period.

FINDINGS

There was a significant difference between the pretest and posttest total mean scores of the intervention group that received psychoeducation (P < .05). There was also a significant difference in depressive thoughts, irritability, and fatigue mean scores between the two groups (P < .05).

PRACTICAL IMPLICATIONS

The use of this approach and its inclusion in nursing care interventions is recommended to reduce PMS symptoms in young adult women.

Emotion Dysregulation of Women with Premenstrual Syndrome

The aim of the current study was to test whether women with premenstrual syndrome (PMS) had difficulties in emotion regulation. In Study 1, we investigated the relationship between the habitual use of emotion-regulation strategies and the severity of PMS (n = 230). The results showed that the severity of PMS was negatively associated with the habitual use of reappraisal, but positively associated with the habitual use of suppression. In Study 2, we first investigated the difference in the spontaneous use of suppression versus reappraisal between women with (n = 42) and without PMS (n = 42) when watching sad film clips. Then we instructed some participants (PMS group = 20, healthy group = 21) to use reappraisal to regulate their emotions induced by a second sad film clip, and the other participants were asked to watch the second film clip freely (PMS group = 22, healthy group = 21). The results showed that there was no significant difference between participants with and without PMS in the self-reported spontaneous use of emotion-regulation strategies. For participants with PMS, increases in spontaneous suppression use were associated with increases in skin conductance level (SCL), while this association was not found among participants without PMS.